Provider Demographics
NPI:1700924248
Name:TONGSON-IGNACIO, JANE ELLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLAINE
Last Name:TONGSON-IGNACIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513377
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3377
Mailing Address - Country:US
Mailing Address - Phone:714-456-8835
Mailing Address - Fax:714-456-6248
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6411
Practice Address - Fax:714-456-5873
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88855207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A888550Medicaid
CA00A888550OtherBLUE SHIELD
CAWA88855AOtherMEDICARE PTAN
CA00A888550OtherBLUE SHIELD